Tissue retractor and method of use

ABSTRACT

Systems, devices and methods related to retractor systems that retract tissue to allow access to a surgical site are described. The retractor systems can include a first rotatable arm attachable to a first blade, a second rotatable arm attachable to a second blade and a third linearly translatable arm attachable to a third blade. An attachment mechanism that is attachable to a fourth blade can be removably coupled to a mount on the frame. The retractors systems can also include two blade systems whereby when the retractor is in a closed configuration, the two blades form an oval opening.

CROSS REFERENCE TO RELATED APPLICATIONS

This Patent Application is continuation of U.S. patent application Ser.No. 13/286,509 filed on Nov. 1, 2011 which is a continuation-in-partapplication claiming priority to U.S. patent application Ser. No.12/722,100, now U.S. Pat. No. 8,353,826 filed on Mar. 11, 2010, theentire contents of which are incorporated by reference.

FIELD OF THE INVENTION

The present disclosure generally relates to medical devices. Inparticular, in one or more embodiments, the present disclosure relatesto methods and devices for retracting tissue in a surgical procedure toallow access to the surgical site.

BACKGROUND OF THE INVENTION

Retractor systems may be used in a variety of different surgicalprocedures to provide an opening through which the doctor may access thesurgical site. In spinal surgeries, for example, a retractor system maybe used to provide the surgeon with access to the patient's spine. Theopening created by the retractor system may, for example, enable thedoctor to insert surgical instruments into the body or enablevisualization of the surgical site using X-ray. One typical retractorsystem may include a plurality of blades coupled to a retractor frame.In use, the blades may be inserted into an incision and then retractedto displace tissue surrounding the incision down to the surgical site.To minimize trauma to the tissue, this tissue displacement shouldgenerally be refined and controlled. However, current retractor systemsmay not provide desired control of the distraction.

Thus, there is a need for improved methods and devices that can be usedfor retracting tissue to provide access to the surgical site.

SUMMARY OF THE INVENTION

Systems, devices and methods related to multi-blade retractor systemsare described below. In some embodiments, a multi-blade retractor systemcomprises a retractor frame comprising a first arm, a second arm, and athird arm coupled to the first and second arms; a first blade coupled toa distal end of the first arm; a second blade coupled to a distal end ofthe second arm; a third blade coupled to a distal end of the third arm;and a removable attachment mechanism capable of attaching to theretractor frame, wherein the attachment mechanism includes an additionalblade to attach to the retractor frame.

In some embodiments, a multi-blade retractor system comprises aretractor frame comprising a first rotatable arm and a second rotatablearm; a first blade coupled to a distal end of the first rotatable arm; asecond blade coupled to a distal end of the second rotatable arm; and anattachment mechanism capable of attaching to the retractor frame,wherein the attachment mechanism is capable of adding an additionalblade to attach to the retractor frame.

In some embodiments, a multi-blade retractor system comprises aretractor frame comprising a first arm and a second arm; a first bladecoupled to the distal end of the first arm; and a second blade coupledto the distal end of the second arm, wherein in a closed configuration,the first blade and the second blade form an oval shaped opening.

BRIEF DESCRIPTION OF THE DRAWINGS

These drawings illustrate certain aspects of the present invention andshould not be used to limit or define the invention.

FIGS. 1 and 2 illustrate a retractor system in a closed configuration inaccordance with some embodiments.

FIGS. 3 and 4 illustrate a retractor system in an open configuration inaccordance with some embodiments.

FIG. 5 illustrates a retractor frame in accordance with someembodiments.

FIG. 6 illustrates a rotatable arm for use in a retractor system inaccordance with some embodiments.

FIG. 7 illustrates a linearly translatable arm and a central gearhousing for use in a retractor system in accordance with someembodiments.

FIG. 8 illustrates a rotatable arm for use in a retractor system inaccordance with one some embodiments.

FIG. 9 is a bottom view of a retractor frame in accordance with someembodiments.

FIG. 10 is a cross-sectional view of a retractor frame in accordancewith some embodiments.

FIG. 11 is a top view of a retractor frame in accordance with someembodiments.

FIG. 12 illustrates a ratchet-locking mechanism in accordance with someembodiments

FIG. 13 illustrates angulation of a retractor blade in accordance withsome embodiments.

FIG. 14 illustrates a top view of an alternative retractor system withfour blades in a closed configuration in accordance with someembodiments.

FIG. 15 illustrates a top view of the retractor system in FIG. 14 in anopen configuration in accordance with some embodiments.

FIG. 16 illustrates a perspective view of a retractor system comprisingthe retractor in FIG. 14 in an open configuration and an instrument inaccordance with some embodiments.

FIG. 17 illustrates a top view of an alternative retractor system with aleft-handed attachment mechanism in accordance with some embodiments.

FIG. 18 illustrates a top view of an alternative retractor system with aright-handed attachment mechanism for an opposite hand in accordancewith some embodiments.

FIG. 19 illustrates a top view of an alternative retractor system withan attachment mechanism having a frame with a multi-axial adjustmentmechanism in accordance with some embodiments.

FIG. 20 illustrates a top view of an alternative retractor system withan attachment mechanism having a different frame with a multi-axialadjustment mechanism in accordance with some embodiments.

FIG. 21 illustrates a top view of an alternative retractor system withan attachment mechanism having a different frame with a multi-axialadjustment mechanism in accordance with some embodiments.

FIG. 22 illustrates a perspective view of a segment of a retractorsystem comprising a handle in accordance with some embodiments.

FIG. 23 illustrates a perspective view of an alternative segment of aretractor system comprising a handle in accordance with someembodiments.

FIG. 24 illustrates a perspective view of an alternative segment of aretractor system comprising a handle in accordance with someembodiments.

FIG. 25 illustrates a top view of a two-blade retractor system accordingto some embodiments.

FIG. 26 illustrates a perspective view of the two-blade retractor systemin FIG. 25.

FIG. 27 illustrates a different perspective view of the two-bladeretractor system in FIG. 25.

FIG. 28 illustrates a top view of a pair of blade attachment members ofthe retractor system in FIG. 25.

FIG. 29 illustrates a perspective view of a dilator according to someembodiments.

FIG. 30 illustrates a top view of a blade attachment member including anextension member and a shim member with an anchor member according tosome embodiments.

FIG. 31 illustrates a side view of a blade including an extensionportion and a shim member according to some embodiments.

FIG. 32 illustrates a top perspective view of the blade of FIG. 31.

FIG. 33 illustrates a back view of the blade including an anchor memberaccording to some embodiments.

FIG. 34 illustrates a back perspective view of the blade of FIG. 33.

FIG. 35 illustrates a front perspective view of the blade of FIG. 33.

FIG. 36 illustrates a side perspective view of a shim member accordingto some embodiments.

FIG. 37 illustrates a top view of the shim of FIG. 36.

FIG. 38 illustrates the anchor member according to one embodiment of theinvention.

FIG. 39 illustrates the extension portion according to one embodiment ofthe invention.

FIG. 40 illustrates the top view of the extension portion of FIG. 39.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

FIGS. 1-4 illustrate a retractor system 10 that may be used to retracttissue in a surgical procedure in accordance with one embodiment of thepresent invention. The retractor system 10 comprises a first blade 12, asecond blade 14, and a third blade 16. The first, second, and thirdblades 12, 14, 16 are each coupled to a retractor frame 18. Theretractor frame 18 comprises a first rotatable arm 20 having a firstblade attachment member 22 for holding and positioning the first blade12. The retractor frame 18 further comprises a second rotatable arm 24having a second blade attachment member 26 for holding and positioningthe second blade 14. The retractor frame 18 further comprises a linearlytranslatable arm 28 having a third blade attachment member 30 forholding and positioning the third blade 16. The first and secondrotatable arms 20, 24 and the linearly translatable arm 28 may beactuated so that the blades 12, 14, 16 may be separated a desireddistance from each other. In addition, the blade attachment members 22,26, and 30 may be actuated to angulate the blades 12, 14, 16, increasingthe distance between the distal ends of the blades 12, 14, 16. In thismanner, tissue surrounding an incision may be retracted providing accessto the surgical site. In embodiments, the first, second, and thirdblades 12, 14, 16 may be individually actuated.

FIGS. 1-2 illustrate the retractor system 10 in a “closed” ornon-retracted configuration, in accordance with one embodiment of thepresent invention. In the closed configuration, the first, second, andthird blades 12, 14, 16 are radially disposed around a central bore 31to form a substantially closed, tube-shaped structure.

FIGS. 3-4 illustrate the retractor system 10 in an “open” or retractedconfiguration, in accordance with one embodiment of the presentinvention. In the open configuration, the first, second, and thirdblades 12, 14, 16 have been moved so that they no longer form atube-shaped structure that is substantially closed. Rather, the firstand second blades 12, 14 have been rotated and angulated and third blade16 has been linearly translated and angulated to enlarge the diameter ofthe central bore about which the blades 12, 14, 16 are arranged.

The first rotatable arm 20 may be actuated by rotation of an actuator32. The actuator 32 may be a fastener, such as a hex screw (e.g., a 10mm hex screw). The actuator 32 may be coupled to a planetary gear 180(shown on FIG. 9) having teeth that engage a first sun gear 34. Theengagement between the actuator 32, the planetary gear 180, and thefirst sun gear 34 may be described as a planetary gear mechanism inaccordance with embodiments of the present invention. In the illustratedembodiments, a ratchet-locking mechanism 38 is included that engagesteeth on the first sun gear 34. As the actuator 32 is turned, the firstrotatable arm 20 should rotate as indicated by arrow 36 with the distalend of the arm 20 moving in an arc. For example, rotation of theactuator 32 in the counter-clockwise direction drives rotation of thefirst rotatable arm 20 as indicated by arrow 36 thereby rotating thefirst blade 12 in an arc away from the second and third blades 14, 16.In an embodiment, the first sun gear 34 is stationary with the planetarygear 180 rotating tooth by tooth along the first sun gear 34. In anembodiment, the ratchet-locking mechanism 38 engages the first sun gear34 to prevent rotation of the first rotatable arm 20 in thecounter-clockwise direction. The first rotatable arm 20 may be releasedfrom its rotated state (FIGS. 3-4) by depressing the lever of theratchet-locking mechanism 38 to allow the first rotatable arm 20 torotate back to its initial position (FIGS. 1-2).

In a similar manner to the first rotatable arm 20, the second rotatablearm 24 may be actuated by rotation of an actuator 40. The actuator 40may be, for example, a fastener, such as a hex screw (e.g., a 10 mm hexscrew). The actuator 40 may be coupled to a planetary gear 182 (shown onFIG. 9) having teeth that engage a second sun gear 42. The engagementbetween the actuator 40, the planetary gear 182, and the second sun gear42 may be described as a planetary gear mechanism in accordance withembodiments of the present invention. It should be understood that useof the term “sun” is not meant to imply that the first and second sungears 34, 42 are circular in shape but rather that the gears function inconjunction with the other components in a manner similar to what iscommonly referred to as a planetary gear. In the illustrated embodiment,a ratchet-locking mechanism 44 is included that engages teeth on thesecond sun gear 42. As the actuator 40 is turned, the second rotatablearm 24 should rotate as indicated by arrow 46 with the distal end of thesecond rotatable arm 24 moving in an arc. For example, rotation of theactuator 40 in the counter-clockwise direction should drive rotation ofthe second rotatable arm 24 as indicated by arrow 46 thereby rotatingthe second blade 14 in an arc away from the first and third blades 12,16. In an embodiment, the second sun gear 42 is stationary with theplanetary gear 182 rotating tooth by tooth along the second sun gear 42.In an embodiment, the ratchet-locking mechanism 44 engages the secondsun gear 42 to prevent rotation of the second rotatable arm 24 in thecounter-clockwise direction. The second rotatable arm 24 may be releasedfrom its rotated state (FIGS. 3-4) by depressing the lever of theratchet-locking mechanism 44 to allow the second rotatable arm 24 torotate back to its initial position (FIGS. 1-2).

The linearly translatable arm 28 may be actuated by rotation of anactuator 48. The actuator 48 may be, for example, a fastener, such as ahex screw (e.g., a 10 mm hex screw). The actuator 48 may be coupled to apinion gear (not shown) that engages teeth on rack portion 50 of thelinearly translatable arm 28. As illustrated, the rack portion 50 may beon the opposite end of the linearly translatable arm 28 from the thirdblade attachment member 30. The engagement between the actuator 48, thepinion gear, and the rack portion 50 may be described as a rack andpinion gear mechanism in accordance with embodiments of the presentinvention. In the illustrated embodiment, ratchet-locking mechanism 52is also included that engages teeth on the rack portion 50. As theactuator 48 is turned, the linearly translatable arm 28 moves in a lineas illustrated in FIGS. 3-4. This will increase the distance between thethird blade 16 and the first and second blades 12, 14. In an embodiment,the ratchet-locking mechanism 42 engages the rack portion 50 to preventtranslation in the opposite direction that would shorten the distancebetween the blades 12, 14, 16. The linearly translatable arm 28 may bereleased from its translated state (FIGS. 3-4) by depressing the leverof the ratchet-locking mechanism 52 to allow the linearly translatablearm 28 to rotate back to its initial position (FIGS. 1-2) without havingto turn the actuator 48.

In accordance with present embodiments, the first, second, and thirdblades 12, 14, 16 may be angulated by respective rotation of actuators54. As used herein, angulation of the blades 12, 14, 16 refers torotation of the distal ends of the blades 12, 14, 16 outwardly andupwardly, resulting in separation of the distal ends. The actuators 54may be, for example, a fastener, such as a hex screws (e.g., 10 mm hexscrews). As illustrated by FIGS. 3-4, each of the actuators 54 may berotated to angulate the first, second, and third blades 12, 14, 16,respectively. As will be discussed in more detailed with respect to FIG.13, rotation of the actuators 54 facilitates this angulation byangulating the blade attachment members 22, 26, 30 to causecorresponding angulation of the blades 12, 14, 16. In an embodiment, theangulation used is an infinite angle adjustment mechanism that iscontrolled by threading.

The first, second, and third blades 12, 14, 16 of the retractor system10 may have one or more holes 58 extending through the blades 12, 14, 16along their respective long axes. The holes 58 may configured to allowpassage of light components, k-wires, or other suitable instrumentsthrough the blades 12, 14, 16. The edges of the blades may be rounded,for example, to minimize the risk of damage to the retracted tissue.While illustrated with three blades, those of ordinary skill in the artwill appreciate the retractor system 10 may include more, or less, thanthree blades configured to move as desired for a particular application.For example, a retractor system may be used that comprises four bladeswith two linearly translatable arms and two rotatable arms.Alternatively, a retractor may be used that comprises two rotatable armsor alternatively one linearly translatable arm and one rotatable arm.

It should be understood that the actuators 32, 40, 48, 54 may beconfigured to engage a variety of different tools to facilitate thedesired rotation. For example, wrenches, screwdrivers, or any othersuitable tools may be used to rotate the actuators 32, 40, 48, 54. Inaddition, while actuators 32, 40, 48, 54 are shown as fasteners, itshould be understood that fasteners are not required to facilitate themovement. Other suitable devices, such as cranks, may be used tofacilitate the desired movement.

An embodiment of the present invention includes using the retractorsystem 10 to retract tissue in a surgical procedure. For example, theretractor system 10 may be placed into an opening (e.g., an incision) inthe patient's tissue with the retractor system 10 in the closedposition. The surgeon (or other operator) may then separately rotateactuator 32 and actuator 40 to rotate the first rotatable arm 20 and thesecond rotatable arm 24, respectively, thus moving the first and secondblades 12, 14 in an arc. The surgeon may also rotate actuator 48 to movethe linearly translatable arm 28 and, thus, the third blade 16, in aline. In this manner, the first, second, and third blades 12, 14, 16 maybe retracted (or spread) to provide enhanced access to the surgicalsite. To further enhance access, the surgeon may rotate each ofactuators 54 to angulate the first, second, and third blades 12, 14, 16.

Turning now to FIGS. 5-11, the retractor frame 18 is illustrated in moredetail in accordance with embodiments of the present invention. Aspreviously mentioned, the retractor frame 18 may comprise a firstrotatable arm 20, a second rotatable arm 24, and a linearly translatablearm 28. A portion of the second rotatable arm 24 is removed on FIG. 11to illustrate interior components of the retractor frame 18. Inaddition, the retractor frame 18 may further comprise a central gearhousing 60. As illustrated, the central gear housing 60 houses the firstsun gear 34 and the second sun gear 42. In accordance with presentembodiments, the first sun gear 34 and the second sun gear 42 areconfigured to facilitate rotation of the first rotatable arm 20 and thesecond rotatable arm 24, respectively.

The first rotatable arm 20 may comprise a first blade attachment member22 having a proximal end 62 and a distal end 64. The first rotatable arm20 may further comprise a base portion 66 having a proximal end 68 and adistal end 70. The proximal end 62 of the first blade attachment member22 may be disposed over the distal end 70 of the base portion 66. Thefirst blade attachment member 22 may be secured to the base portion 66by a pivot pin (not shown). The distal end 64 of the first bladeattachment member 22 may be configured to receive the first blade 12(illustrated on FIGS. 1 and 3). For example, the distal end 64 may havea slot 72 that receives the first blade 12. A notch 74 in the distal end64 may receive a corresponding protrusion in the first blade 12.Fastener 76 may secure the first blade 12 in the blade attachment member22. As illustrated, the fastener 76 may include one or more radiallyextending protrusions 78. To secure the first blade 12, the first blade12 may be inserted into slot 72 until the protruding portion of theblade 12 lands on the notch 74. The fastener 76 may be rotated until oneof the protrusions 78 extends over the top of the first blade 12 toprevent its removal from the slot 72.

The base portion 66 may have a finger grip at the proximal end 68 thatmay be used to facilitate a controlled return of the first rotatable arm20 after depression of the ratchet-locking mechanism 38. Top and bottomannular-shaped members 80, 82 may extend laterally from the firstrotatable arm 22. Slot 84 may be formed in the first rotatable arm 20for receiving the central gear housing 60. Pin 86 may extend through theannular-shaped members 80, 82 to secure the central gear housing 60 inthe slot 84 with the teeth of the first sun gear 34 engaging theplanetary gear 180. Set screw 87 should secure the pin 88 in the centralgear housing 60. Pin 88 may extend through holes 90 in the upper andlower portions 92, 94 of the base portion 66. Pin 88 should be coupledto spring 170 for spring-loading the first rotatable arm 20. Upper slot96 may be formed in the upper portion 92 of the base portion 66 toprovide access to the central gear housing 60 and other components ofthe retractor frame 18. As illustrated by FIG. 9, there may be acorresponding lower slot 98 formed in the lower portion 94 of the baseportion 66 that can provide access to the central gear housing 60 andother components of the retractor frame 18.

The second rotatable arm 24 may comprise a second blade attachmentmember 26 having a proximal end 100 and a distal end 102. The secondrotatable arm 24 may further comprise a base portion 104 having aproximal end 106 and a distal end 108. The proximal end 100 of thesecond blade attachment member 26 may be disposed over the distal end108 of the base portion 104. The second blade attachment member 26 maybe secured to the base portion 104 by a pivot pin 105 (shown on FIG.12). The distal end 102 of the second blade attachment member 26 may beconfigured to receive the second blade 14 (illustrated on FIGS. 1 and3). For example, the distal end 102 may have a slot 110 that receivesthe second blade 14. A notch 112 in the distal end 102 may receive acorresponding protrusion in the second blade 14. Fastener 114 may securethe second blade 14 in the second attachment member 26. As illustrated,the fastener 114 may include one or more radially extending protrusions116. To secure the second blade 14, it may be inserted into slot 110until the protruding portion of the blade 14 lands on the notch 112. Thefastener 114 may then be rotated until one of the protrusions 116extends over the top of the second blade 14 to prevent its removal fromthe slot 110.

The base portion 104 may have a finger grip at the proximal end 106 thatmay be used to facilitate a controlled return of the second rotatablearm 24 after depression of the ratchet-locking mechanism 38. Top andbottom annular-shaped members 118, 120 may extend laterally from thesecond rotatable arm 26. Slot 122 may be formed in the second rotatablearm 24 for receiving the central gear housing 60. Pin 86 may extendthrough the annular-shaped members 118, 120 to secure the central gearhousing 60 in the slot 122 with the teeth of the second sun gear 42engaging the planetary gear 182. Pin 124 may extend through holes 126 inthe upper and lower portions 128, 130 of the base portion 104. Pin 124should be coupled to spring 168 for spring-loading the second rotatablearm 24. Upper slot 132 may be formed in the upper portion 128 of thebase portion 104 to provide access to the central gear housing 60 andother components of the retractor frame 18. As illustrated by FIG. 9,there is a corresponding lower slot 134 formed in the lower portion 130of the base portion 104 that can provide access to the central gearhousing 60 and other components of the retractor frame 18.

The linearly translatable arm 28 may comprise a third blade attachmentmember 30 and a rack portion 50 separated from third blade attachmentmember 30 by a slotted middle portion 136. In an embodiment, the rackportion 50 may be at least partially slotted. The third blade attachmentmember 30 may have a proximal end 138 and distal end 140. The slottedmiddle portion 136 may comprise a distal end 142 on which the proximalend 138 of the third blade attachment member 30 may be disposed. A pinmay secure the third blade attachment member 30 to the slotted middleportion 136. The distal end 140 of the third blade attachment member 30may be configured to receive the third blade 16 (illustrated on FIGS. 1and 3). For example, the distal end 140 may have a slot 144 thatreceives the third blade 16. A notch 146 in the distal end 140 mayreceive a corresponding protrusion in the third blade 16. Fastener 148may secure the third blade 16 in the third blade attachment member 30.As illustrated, the fastener 148 may include one or more radiallyextending protrusions 150. To secure the third blade 16, it may beinserted into slot 144 until the protruding portion of the blade 16lands on the notch 146. The fastener 148 may then be rotated until oneof the protrusions 150 extends over the top of the third blade 16 toprevent its removal from the slot 144. A protrusion 160 in the bottom ofthe slot 144 may further secure the third blade 16 in the slot 144.

The slotted middle portion 136 may be coupled to the third bladeattachment member 30 at its distal end 142 with the rack portion 50 onits other end. As illustrated, the slotted middle portion 136 may extendinto a through passageway 152 in the central gear housing 60. Theslotted middle portion 136 separates the rack portion 50 from the thirdblade attachment member 30. As illustrated, the rack portion 50 mayextend from the through passageway 152 in the central gear housing 60.The rack portion 50 may further comprise rack teeth 153 that shouldengage with the actuator/pinion gear 48. Ratchet-locking mechanism 52may further engage teeth 154 on the rack portion 50. The rack portion 50may further comprise features for securing the retractor system 10 to anarm (not illustrated). Those of ordinary skill in the art shouldunderstand that the arm may be used to provide, for example, aconnection between the retractor system 10 and an operating table. Thefeatures for securing the retractor system 10 to the arm may include,for example, a pair of slots 156 and semi-elliptical openings 158 onopposing sides of the rack portion 50.

The central gear housing 60 may comprise a first sun gear 34 on a firstside and a second sun gear 42 on a second side. In the illustratedembodiment, the central gear housing 60 is generally disc shaped with arim 162 about which the first sun gear 34 and the second sun gear 42 areindividually rotatable. As illustrated, the rim 162 may further compriseteeth 164 that engage the ratchet-locking mechanism 44 of the secondrotatable arm 24. While not illustrated, there may be correspondingteeth on the opposite side of the rim 162 for engaging theratchet-locking mechanism 38 for the first rotatable arm 20. A centralopening may be disposed in the central gear housing 60 through which pin86 may be inserted. Central gear housing 60 may further comprise athrough passageway 152 having a rectangular cross section. Central gearhousing 60 may further comprise channels 166. In the illustratedembodiment, spring 170 may be coupled to pin 88 for providing the forceto return the first rotatable arm 20 to its initial position when theratchet-locking mechanism 38 is released. As further illustrated, pin124 may be inserted into the other one of the channels 166. Spring 168may be coupled to pin 124 for providing force to return the secondrotatable arm 24 to its initial position when the ratchet-lockingmechanism 44 is released. Central gear housing 60 may further compriseupwardly extending arm 172 to which arm attachment plate 174 may beattached. Arm attachment plate 174 may comprise features for attachingthe retractor system 10 to a table connector, such as an arm. Forexample, arm attachment plate 174 may comprise slots 176 andsemi-elliptical openings 178. As illustrated, ratchet-locking mechanism52 may be coupled to the central gear housing 60 so as to engage teeth154 on the rack portion 50 of the linearly translatable arm 28. Asfurther illustrated, actuator 48 may extend through an opening in thecentral gear housing 60 so that a connected pinion gear (notillustrated) also engages the rack teeth 153.

FIG. 12 illustrates the ratchet-locking mechanism 44 in more detail inaccordance with one embodiment of the present invention. In anembodiment, the ratchet-locking mechanism 44 includes a lever 180 and anose 182. As illustrated, the nose 182 of the ratchet-locking mechanism44 engages teeth 164 on the central gear housing 60. As previouslydiscussed, rotation of the actuator 54 in the counter-clockwisedirection should drive the planetary gear 182 tooth by tooth along thesecond sun gear 52. Rotation of the actuator 54 should drivecorresponding rotation of the second rotatable arm 24 in thecounter-clockwise direction. The nose 182 of the ratchet-lockingmechanism 44 should engage the teeth 164 of the second sun gear 52 toallow movement of the second rotatable arm 24 in one direction, i.e.,the counter-clockwise direction. The second rotatable arm 24 can bereleased from this rotated position by depressing the lever 180. Thespring 168 should generally provide the force need to return the secondrotatable arm 24 to its initial position when the lever 180 is released.While the previous discussion of FIG. 12 is with respect to theratchet-locking mechanism 44, it should be understood thatratchet-locking mechanism 38 may be operated in a similar manner torestrict rotation of the first rotatable arm 20. It should further benoted that, while the previous discussion describes a ratchet-lockingmechanism, other suitable devices for allowing movement of the rotatablearms in one direction may be used in accordance with the presentinvention.

FIG. 13 describes angulation of the blade attachment member 22 inaccordance with one embodiment of the present invention. As previouslydiscussed, the first rotatable arm 20 comprises blade attachment member22 coupled to the distal end 70 of the base portion 66. As illustrated,actuator 54 may secure the blade attachment member 22 onto the baseportion 66. The actuator 54 may be threaded, for example, into acorresponding opening 184 in the base portion 66. The pin 107 (See FIG.12) pivotably connects the attachment member 22 to the screw shaft ofthe actuator 54. A second pin 105 (See FIG. 13) connects the attachmentmember 22 through the base portion of the 66. The screw head of theactuator is provided with a portion that allows the attachment member tobe retained within the head portion of the actuator and is pivotablyrotatable when the actuator 54 is manipulated. The pin 107 and pin 105create two separate axis of rotations. As the actuator is manipulatedthe attachment member 22 is rotated along the axis of rotation of pin105. In an embodiment, the opening 184 may be angled, in that the axisof the opening 184 may be at an angle with respect to the z-axis of thefirst rotatable arm 20. Accordingly, as the actuator 54 is rotated, theblade attachment member 22 should pivot. In this manner, the bladeattachment member 22 and, thus, the first blade 12 may be angulated.While the previous discussion of FIG. 12 and FIG. 13 is with respect toangulation of the first blade attachment member 22, it should beunderstood that second and third blade attachment members 26, 30 may beangulated in a similar manner. It should further be noted that, whilethe previous discussion describes an angled actuator for angulating theblade attachment member 22, 26, and 30, other suitable mechanisms forfacilitating the desired blade angulation may be used in accordance withthe present invention.

Additional Embodiments of Retractor Systems

Additional embodiments of retractor systems are discussed below. Thesesystems encompass different mechanisms for opening and closing theretractors, as well as different components for attaching to theretractors.

FIG. 14 illustrates a top view of an alternative retractor system withfour blades in a closed configuration in accordance with someembodiments. The retractor system 200 includes four arms 222, 226, 228and 230. The arms include proximal sections 232, 236, 238 and 240 anddistal sections 242, 246, 248 and 250 respectively. The distal sectionsof the arms are capable of outward expansion to facilitate tissueretraction, as shown in FIG. 15.

Each of the arms 222, 226, 228 and 230 are operably connected toindividual blades 212, 216, 218 and 220. The blades 212, 216, 218 and220 are configured to be slidable relative to an inner wall of theirrespective arms. As the distal sections 242, 246, 248 and 250 expandoutwardly, the blades 212, 216, 218 and 220 slide outwardly from thearms, thereby helping to expand the area of tissue retraction asdiscussed further below.

In some embodiments, the blades comprise extensions that are continuouswithout slots or perforations, while in other embodiments, the bladescomprise extensions that include slots and/or perforations. In someembodiments, the blades are formed of stainless steel, titanium, ormetallic alloy. The blades can also include one or more polymericmaterials. The blades can also be formed of or coated with a radiolucentor semi-radiolucent material to assist in x-ray procedures. In someembodiments, the distal portions of the blades can be smooth and curved,while in other embodiments, the distal portions can be toothed orcombed.

FIG. 15 illustrates a top view of the retractor in FIG. 14 in an openconfiguration in accordance with some embodiments. In this figure, thedistal sections 242, 246, 248 and 250 of the arms have been expandedoutwardly, while the proximal sections 232, 236, 238 and 240 have beenbrought closer together. To facilitate this movement, the retractor caninclude one or more actuators 283, 285 that when actuated (e.g.,pressed, turned or rotated), cause expansion or contraction of the arms.For example, as shown in FIG. 15, rotation of actuator 283 can cause thedistal sections 242, 248 of arms 222, 228 to expand outwardly, whilerotation of actuator 285 can cause the distal sections 246, 250 of arms226, 230 to expand outwardly. In some embodiments, arms 222 and 228 canhinge around actuator 283, while arms 226 and 230 hinge around actuator285. A third actuator 287 can also be provided to expand and/or contractarms 292 and 293, thereby further helping to expand the tissue retractedarea.

As shown in FIG. 15, the retractor blades slide outwardly relative totheir respective arms during expansion. As the blades slide outwardly,they proceed to push tissue back and create a larger retraction areathrough which a surgical procedure can be performed. In someembodiments, the blades can be angled or tilted outwardly to provide alarge visualization field into a surgical site. While the illustratedembodiment illustrates four retractor blades, in other embodiments, moreor less than four blades can be operated in a similar manner. Forexample, in another embodiment, a retractor blade having six blades canbe provided to expand in a similar manner.

FIG. 16 illustrates a perspective view of a retractor system comprisingthe retractor in FIG. 14 and an instrument in accordance with someembodiments. As shown in the figure, the instrument 290 is configured torotate the actuator 287. The same instrument 290 can be used to rotatethe other actuators 283 and 285 as well. In other embodiments, theactuators can be rotated manually by a user's hand.

Various embodiments of an alternative retractor system are shown inFIGS. 17-24. The retractor system 300 includes a unique attachmentmechanism 368 that is capable of attaching one or more additional bladesto an existing retractor system, thereby further facilitating tissueretraction.

FIG. 17 illustrates a top view of an alternative retractor system with aleft-handed attachment mechanism in accordance with some embodiments.The retractor system 300 comprises many similar components as theretractor system 10 in FIG. 1, including a frame 318 comprising a firstrotatable arm 320 having a first blade attachment member 322 for holdingand positioning a first blade, a second rotatable arm 324 having asecond blade attachment member 326 for holding and positioning a secondblade, and a linearly translatable arm 328 having a third bladeattachment member 330. The first and second rotatable arms 320, 324 andthe linearly translatable arm 328 may be actuated so that the blades(not shown) may be separated a desired distance from each other. Inaddition, the blade attachment members 322, 326 and 330 may be actuatedto angulate the blades thereby increasing the distance between thedistal ends of the blades. Further, the retractor system 300 can includean actuator 332 for the first rotatable arm 320, an actuator 340 for thesecond rotatable arm 324, and an actuator 348 for the lineartranslatable arm 328. Additional actuators 354 help to angulate theblades.

The retractor system 300 further comprises a unique attachment mechanism368 that is capable of attaching one or more additional blades to theexisting retractor system. The attachment mechanism 368 is configured toattach to an unoccupied mount 376 located on the frame 318 of theretractor system 300. In some embodiments, the mount 376 is in asubstantially central portion of the retractor system 300 such thatattachment of the attachment mechanism to the retractor system is strongand robust. As shown in FIG. 17, the attachment mechanism 368 includesone or more arms that extend from the mount 376. The arms can bestraight or cured. A fourth blade attachment member 371 is positioned ata distal section of the attachment mechanism 368 and is configured toreceive a fourth blade to assist in separation and retraction of tissue.The attachment mechanism 368 thus advantageously provides a convenientmechanism to attach additional blades to retractor systems, therebyenhancing the efficacy of a desired retraction. If an additional bladeis desired, a user such as a surgeon can simply attach the attachmentmechanism 368 to a mount on the existing retractor system to therebyenhance tissue separation.

In some embodiments, portions of the attachment mechanism 368, such asthe fourth blade attachment member 371, can have translated motion.Translated motion can be performed using a rack and pinion configuration345 as shown in FIG. 17. When a user presses down on the handle 345,this can result in translational motion of the fourth blade attachmentmember 371. In some embodiments, the attachment mechanism 368 can alsoinclude an actuator 374 for angling the fourth blade.

In the illustrated embodiment, the attachment mechanism 368 is suitablefor use by a left-handed user. As shown in FIG. 18, the attachmentmechanism 368 can also be configured for use by a right-handed user,thereby having increased versatility.

While the illustrated embodiments show a single attachment mechanism 368for adding a fourth blade, more than one attachment mechanism can beprovided to add two, three, four or more blade members.

FIG. 19 illustrates a top view of an alternative retractor system withan attachment mechanism having a frame with a multi-axial adjustmentmechanism in accordance with some embodiments. The retractor system 300includes an attachment mechanism 368 in a “J-configuration” having afourth blade attachment member 371. Translational movement of the fourthblade attachment member can be performed using a rack and pinion system342.

Advantageously, as shown in FIG. 19, the retractor system 300 isoperatively coupled to a long arm 380 and short arms 382. The long arm380 and short arms 382 can be used to position portions of the retractorsystem 300 in different orientations and angles. The illustrated system300 thus provides more freedom to users in how to position the retractorsystem 300 in space in a controlled manner.

FIG. 20 illustrates a top view of an alternative retractor system withan attachment mechanism having a different frame for multi-axialadjustment in accordance with some embodiments. The retractor system 300includes a long arm 380 and short arms 382 in a different configurationfrom that in FIG. 19. The illustrated embodiment thus shows thevariability in orientation and placement of the attachment mechanism 368that is provided by having long and short arms.

FIG. 21 illustrates a top view of an alternative retractor system withan attachment mechanism having a different frame with a multi-axialadjustment mechanism in accordance with some embodiments. The retractorsystem 300 includes a long arm 380 and shorts arms 382. In thisembodiment, the short arms 382 are configured to assist in fixing thelocation of the fourth blade within the system.

FIGS. 22-24 illustrate perspective views of a handle portion of aretractor system according to some embodiments. As shown in FIG. 22, thehandle portion 390 includes a handle 392 and a clamp member 394 that iscapable of clamping onto different arms of the retractor system 300.Additional clamp members 396 can also be provided to adjust the positionand orientation of the arms, as shown in FIG. 23. By applying a force tothe handle portion 390, the arms of the retractor system 300 can assumevarious positions and orientations. With such handle portions, theretractor system can advantageously provide a multitude of angleadjustments in a controlled manner.

Various embodiments of an alternative retractor system having two bladesare shown in FIGS. 27-40. The blades advantageously comprise one or moreslots to receive pins, shims, or other components to assist in aretraction procedure.

FIG. 25 illustrates a top view of a two-blade retractor system accordingto some embodiments. The retractor system 400 comprises a firstrotatable arm 420 including a first blade attachment member 422 and asecond rotatable arm 424 including a second blade attachment member 426.A first blade 412 can be attached to the first blade attachment member422, while a second blade 414 can be attached to the second attachmentmember 424. The first rotatable arm 420 can be actuated by rotation ofactuator 432, while the second rotatable actuator 424 can be actuated byrotation of actuator 440. Additional actuators 454 can be provided toangulate blades attached to the blade attachment members. The retractorsystem 400 further includes a pair of holes 58 that can be configured toallow passage of light components, k-wires, or other suitableinstruments through the blades 412, 414.

The pair of blade attachment members are configured to receive the firstblade 412 and the second blade 414 as shown in FIG. 28. Advantageously,the blade attachment members are configured to receive the blades 412and 414 such that the two blades are opposed and form a compact ovalshape in the retractor's closed position. Advantageously, the two bladesare capable of simple separation and contraction via movement of theactuators 432 and 440.

FIGS. 26 and 27 illustrate additional perspective views of the two-bladeretractor system in FIG. 25. From these viewpoints, a first blade 412 isshown attached to the blade attachment member 426. The first blade 412advantageously includes an inner channel 418 including one or moreinsertion grooves 417, 419. Additional components, such as the shimmember 480 in FIG. 36, can be advantageously attached to the first blade412 via the grooves in the inner channel. For example, to attach theshim member 480 to the first blade 412, wings 481, 482 of the shimmember 480 (shown in FIG. 36) can be downwardly inserted into thegrooves 417, 419 in the blade, thereby resulting in the assemblies shownin FIG. 35. The shim member 480 includes an opening 484 for receiving ananchor member 436, which can be secured into a bone member. More detailsregarding the shim member 480 and its advantages are discussed below.

FIG. 28 illustrates a top view of the blade attachment members 412 and414. From this viewpoint, the distinct oval shape formed by theattachment members 412, 414 is clearly shown.

FIG. 29 illustrates a perspective view of a dilator for use with theretractor system in FIG. 25. The dilator 430 comprises a handle 432operably attached to dilating outer tube 434 and dilating inner tube436. Advantageously, the dilator tubes 434, 436 are oval shaped toaccommodate the shape of the retractor system's blade attachment members422, 426 in their closed position.

FIG. 30 illustrates a top view of a blade attachment member having ablade member with an extension portion attached thereto according tosome embodiments. The extension portion 440, shown on its own in FIGS.39 and 40, comprises an insertion portion 441 and blocking member 443.As shown in FIG. 30, the insertion portion 441 is capable of slidinginto the channel of the blade 412, thereby operably connecting theextension portion 440 to the blade 412. When the retractor 400 isexpanded into an open configuration from its closed position, the pairof blades attached to the blade attachment members will separate fromone another and expand outwardly. The separation of the blades resultsin a gap between the two blades. Advantageously, by affixing one or moreextension portions 440 to the blades, the one or more extension portionscan serve as a barricade for the gaps, thereby preventing undesiredtissue from entering through the gaps into the retractor system.

In the embodiment in FIG. 30, the retractor system 400 further includesa shim member for receiving an anchor member 436. The shim member can beinserted into the channel of the blade as shown in FIGS. 35 and 36.

FIGS. 31 and 32 illustrate different views of a first blade includingthe extension portion 440 and shim member 480. From these views, theattachment of the shim member 480 and the extension member 440 to theblade 412 is clearly shown.

As shown in the figures, the shim member 480 can be inserted through thechannel 418 of the blade 412. The shim member 480 is configured toreceive the anchor member 436, which can anchor the blade, and thus theretractor system 400, to a bone member. Advantageously, when theretractor system 400 is anchored to a bone member via the anchor member436, the retractor system 400 can use the anchor member 436 as leverageduring the expansion and opening of the retractor blades. It has beenfound that using an anchor member 436 with a diameter of at least 3.0 mmwill serve as a suitable anchor that will reduce the risk of breaking ofthe anchor member during the opening of the retractor blades.

After the shim member 480 is positioned in the blade 412, the extensionportion 440 can then be attached to the blade 412. The insertion portion441 of the extension portion 440 can be downwardly inserted through thegrooves of the blade 412. As shown in FIGS. 31 and 32, in someembodiments, the extension portion 440 can rest on top of a portion ofthe shim member 480 that is positioned in the grooves of the blade. Oneskilled in the art will appreciate that while FIGS. 31 and 32 illustrateboth a shim member 480 and an extension portion 440 attached to theblade, the use of either of the shim member and the extension portion isoptional.

FIGS. 33-35 illustrate different views of a blade with an anchor memberattached thereto. As shown in the figures, the anchor member 436 extendsfrom a distal portion of the blade 412, such that the anchor member 436is capable of fixation into a bone member, such as a vertebral body.

FIGS. 36 and 37 illustrate different views of a shim member according tosome embodiments. The shim member 480 includes wings 481, 482 that arecapable of inserting into grooves of a blade. The shim member 480further includes opening 484 for receiving an anchor member.

The retractor system in FIGS. 25-40 can operate as follows. A dilatorhaving a plurality of tubes can be inserted adjacent a surgical site.The dilator's tubes can be oval, as shown in FIG. 29. Following the useof the dilator, a retractor system as shown in FIG. 25 can be provided.The retractor system is configured to include at least two bladeattachment members that each attach to a blade member. In theretractor's closed position, the blade members form an oval opening. Byturning actuators on the retractor, the blade members can be configuredto open and close, as well as angulate, to assist in retraction oftissue. Optionally, a shim member is provided in one or more of theblade members to receive an anchor member. The shim member can beslidably inserted down one or more of the blade members. In someembodiments, the anchor member can have a diameter of 3 mm or greater.The anchor member can be inserted into the shim member and through avertebral body, thereby helping to provide leverage while the retractorblades are expanded. Optionally, an extension member can be providedthat serves as a barricade to gaps upon extension of the retractorblades.

While it is apparent that the invention disclosed herein is wellcalculated to fulfill the objects stated above, it will be appreciatedthat numerous modifications and embodiments may be devised by thoseskilled in the art.

What is claimed is:
 1. A multi-blade retractor system comprising: aretractor frame comprising a first arm, a second arm, and a third armcoupled to the first and second arms; a first blade coupled to a distalend of the first arm; a second blade coupled to a distal end of thesecond arm; a third blade coupled to a distal end of the third arm; andwherein the third blade includes an anchor member receiving portion at adistal end of the third blade, wherein the anchor member receivingportion is configured to receive an anchor member capable of fixationinto a bone member.
 2. The retractor system of claim 1, wherein thefirst arm is rotatable.
 3. The retractor system of claim 2, wherein thesecond arm is rotatable.
 4. The retractor system of claim 1, wherein thethird arm is linearly translatable.
 5. The retractor system of claim 1,wherein the removable attachment mechanism is attachable to a mountpositioned on the retractor frame.
 6. The retractor system of claim 1,wherein the anchor member receiving portion is removable from the thirdblade.
 7. A multi-blade retractor system comprising: a retractor framecomprising a first rotatable arm and a second rotatable arm; a firstblade coupled to a distal end of the first rotatable arm; a second bladecoupled to a distal end of the second rotatable arm; and a third bladecoupled to a distal end of a third arm, wherein the third blade includesgrooves for receiving a shim member, wherein the shim member includes anopening for receiving an anchor member.
 8. The retractor system of claim7, wherein the shim member includes wings that are capable of insertinginto the grooves of the third blade.
 9. The retractor system of claim 7,wherein the opening of shim member has diameter of at least 3.0 mm. 10.The retractor system of claim 7, wherein the third blade is linearlytranslatable.
 11. The retractor system of claim 7, further comprising anattachment mechanism capable of attaching to the retractor frame,wherein the second attachment mechanism is capable of adding anadditional blade to attach to the retractor frame.
 12. The retractorsystem of claim 11, wherein the attachment mechanism comprises a rackand pinion system.
 13. A multi-blade retractor system comprising: aretractor frame comprising a first arm, a second arm, and a third armcoupled to the first and second arms; a first blade coupled to a distalend of the first arm; a second blade coupled to a distal end of thesecond arm; a third blade coupled to a distal end of the third arm; andwherein the first blade, the second blade and the third blade include ananchor member receiving portion at a distal end of the third blade,wherein the anchor member receiving portion is configured to receive ananchor member capable of fixation into a bone member.
 14. The retractorsystem of claim 13, wherein the first arm is rotatable.
 15. Theretractor system of claim 14, wherein the second arm is rotatable. 16.The retractor system of claim 13, wherein the third arm is linearlytranslatable.
 17. The retractor system of claim 13, wherein a removableattachment mechanism is attachable to a mount positioned on theretractor frame.
 18. The retractor system of claim 13, wherein theanchor member receiving portion is removable from the first blade,second blade and third blade.